The importance of self-management for better treatment outcomes for HIV patients in a low-income setting: perspectives of HIV experts and service providers.

BACKGROUND: Self-management is the most important strategy to improve quality of life in patients with a chronic disease. Despite the increasing number of people living with HIV (PLWH) in low-income countries, very little research on self-management is conducted in this setting. The aim of this research is to understand the perspectives of service providers and experts on the importance of self-management for PLWH. METHODS: A systematizing expert interview type of qualitative methodology was used to gain the perspectives of experts and service providers. The study participants had experience in researching, managing, or providing HIV service in east and southern African (ESA) countries. All the interviews were audio recorded, transcribed, and translated to English. The quality of the transcripts was ensured by randomly checking the texts against the audio record. A thematic analysis approach supported by Atlas TI version 9 software. RESULT: PLWH face a variety of multi-dimensional problems thematized under contextual and process dimensions. The problems identified under the contextual dimension include disease-specific, facility-related, and social environment-related. Problems with individual origin, such as ignorance, outweighing beliefs over scientific issues, low self-esteem, and a lack of social support, were mostly highlighted under the process dimensions. Those problems have a deleterious impact on self-management, treatment outcomes, and the quality of life of PLWH. Low self-management is also a result of professional-centered service delivery in healthcare facilities and health service providers' incapacity to comprehend a patient's need beyond the medical concerns. Participants in the study asserted that patients have a significant stake in enhancing treatment results and quality of life through enhancing self-management. CONCLUSION AND RECOMMENDATION: HIV patients face multifaceted problems beyond their medical issues. The success of medical treatment for HIV is strongly contingent upon patients' self-management practices and the supportive roles of their family, society, and health service providers. The development and integration of self-management practices into clinical care will benefit patients, their families, and the health system.

Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis.

INTRODUCTION: Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS: This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT: PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION: PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.

Impact of quality improvement interventions on facility readiness, quality and uptake of maternal and child health services in developing regions of Ethiopia: a secondary analysis of programme data.

BACKGROUND: Quality improvement intervention (QI) was implemented from 2018 to 2021 in health facilities of developing regional states of Ethiopia. The main objective of this study was to examine the impact of QI interventions on facility readiness, service availability, quality and usage of health services in these regions. METHODS: We used district health information system data of 56 health facilities (HFs). We also used baseline and endline QI monitoring data from 28 HFs. Data were summarised using descriptive statistics and various tests. Regression analysis was employed to examine the impact of QI interventions on various outcomes. RESULT: The QI intervention improved readiness of HFs, service availability and quality of maternal and child health service delivery. The mean availability of basic amenities increased from 1.89 to 2.89; HF cleanliness score increased from 4.43 to 5.96; family planning method availability increased from 4 to 5.75; score for emergency drugs at labour ward increased from 5.32 to 7.00; and the mean score for basic emergency obstetric and newborn care service availability increased from 5.68 to 6.75; intrauterine contraceptive devices removal service increased from 39.3% to 82.1%; and partograph use increased from 53.6% to 92.9%. HFs that use partograph for labour management increased by 39.3%. The QI intervention increased the quality of antenatal care by 29.3%, correct partograph use by 51.7% and correct active third-stage labour management, a 19.6% improvement from the baseline. The interventions also increased the service uptake of maternal health services, but not significantly associated with improvement in contraceptive service uptake. CONCLUSION: The integrated QI interventions in HFs could have an impact on facility readiness for service delivery, service accessibility and quality of service delivery. The effectiveness of the QI intervention should be evaluated using robust methods, and efforts to enhance contraceptive services through a QI approach requires further study.

Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach.

BACKGROUND: Ethiopia has been providing health care to its rural population since 2004 using female Community Health Workers called Health Extension Workers (HEWs). The HEWs are credited with several achievements in improving the country's health indicators. However, information about the HEWs' motivation and job satisfaction is limited. The aim of this study was to assess the HEWs' motivation and job satisfaction, as well as the factors that influence them. METHODS: A mixed-methods study was nested within a national health extension program assessment conducted from March 01 to May 31, 2019. A structured questionnaire which looked at motivation and satisfaction with Likert type single-question and multiple-item measures was used to collect quantitative data from 584 HEWs. Focus group discussion and in-depth interviews were used to gather qualitative data. Means and percentages were used to descriptively summarize important variables. Linear regression was used to identify factors associated with job satisfaction. The qualitative data was analysed thematically. RESULTS: Overall, 48.6% of HEWs were satisfied with their job, with a mean score of 2.5 out of 4.0. The result showed a high level of satisfaction with autonomy (72%), relationships with co-workers (67%), and recognition (56%). Low level of satisfaction was linked to pay and benefits (13%), opportunities for promotion (29%), and education (34%). Regression analysis showed that HEWs in the age category of 30 years and older had lower satisfaction scores as compared to HEWs in the age category of 18-24 years (adjusted ß = - 7.71, 95% CI: - 14.42, - 0.99). The qualitative result revealed that desire to help their community, recognition or respect gained from the community, and achievement were the major motivating factors. In contrast, inadequate pay and benefit, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunity to change workplace were the demotivating factors. CONCLUSIONS: The overall job satisfaction of HEWs was low; extrinsic factors, such as inadequate pay, limited education and career advancement opportunities were the major sources of demotivation. Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation.

Relevance of the Health Extension Program to the current Health Needs and Evolving Demands of Rural Ethiopia: A Mixed-Method Analysis.

Background: Ethiopia has been implementing a health extension program (HEP) to respond to the high maternal and child mortality in rural communities. HEP has brought tremendous contributions to improved access and coverage of primary healthcare in the last 15 years. Despite its attributions, attention to HEP has declined in recent years due to several reasons. This study is designed to explore HEP's relevance to the current healthcare needs of the rural communities. Methods: This study is a nested cross-sectional mixed-method to the overall HEP's evaluation between March and May 2019. Descriptive statistics were used on qualitative and quantitative assessment. A literature review supplemented the assessment. A representative quantitative sample of 11,746 women, men, and young girls; a qualitative sample of 268 key informants from Kebele administrators, HEWs, program people in the health system and focus groups from community leaders, men and women from 185 Kebeles in 62 woredas were selected. A thematic approach was used for qualitative analysis. Results: Rural communities and program managers asserted that HEP's service packages with the existing service delivery modalities were relevant. Eighty-two percent of men and women and 77% of young girls confirmed this relevance. Besides the existing packages, additional curative services for adults and children were recommended with emphasis on the pastoralist community. HEP's service uptake has declined as over 86% of targeted rural communities bypassed HPs due to unavailability of services and capacity problems of HEWs. Conclusion: The current HEP packages with the existing service delivery modalities are still relevant to the rural communities' health needs. However, on-going changes to address the evolving demands of the targeted rural communities are crucial.

Does Combining Antenatal Care Visits at Health Posts and Health Centers Improve Antenatal Care Quality in Rural Ethiopia?

Background: Even though quality maternal care is crucial for the well-being of women and their newborns, the inferior quality of antenatal care in rural Ethiopia is a timely concern. This study aimed to investigate the effects of combining antenatal care visits at health posts and health centers on improving antenatal care quality in rural Ethiopia. Methods: Using the 2019 Ethiopia Health Extension Program assessment done by MERQ, we extracted and analyzed the survey responses of 2,660 women who had received at least one antenatal visit from a primary health care unit. We measured the cumulative count of quality of antenatal care using the Donabedian model. To model the differences in the quality of antenatal care at health posts and health centers, we used zero-truncated Poisson regression and reported incidence risk ratios with their 95% confidence intervals. Results: The quality of antenatal care increased by 20% (adjusted IRR= 1.20 [1.12-1.28]) when antenatal care reception was mixed at health posts and health centers, compared to those who received all antenatal care only from health posts. Quality differences based on socioeconomic status and setting variations were observed as predictors of quality of care, even if women received antenatal care at both health posts and health centers. Conclusions: Combining antenatal care provision from health posts and health centers should be sustained as one of the antenatal care quality improvement strategies in rural parts of Ethiopia while ensuring the equitable provision of quality care across socioeconomic groups and between agrarian and pastoral settings.

Ethiopian Health Extension Workers' Training Status and Perceived Competency.

Background: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre-service training status and perceived competency in Ethiopia. Methods: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross-sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. Result: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. Conclusions: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs.

The Effect of Community Health Information System on Health Care Services Utilization in Rural Ethiopia.

Background: In Ethiopia, the community health information system (CHIS) is implemented at the health post (hp) level with the aim of improving service delivery and use. We conducted a national level assessment of CHIS utilization and explored the associations of CHIS utilization with use of antenatal care (ANC), postnatal care (PNC), institutional delivery and child immunization in rural Ethiopia. Methods: We conducted a cross-sectional study measuring community-based health service use and HP based CHIS assessment from March to May 2019. Data were collected from 343 HPs and 2,864 women who delivered in the last five years, and multistage sampling was used to select the study subjects. We used descriptive statistics for CHIS implementation and service utilization and multilevel logistic regression to investigate the association of CHIS implementation with maternal and child health care services use. Results: Fifty five percent of the HPs were implementing CHIS. These HPs were using a paper-based household data collection tool called family folder (FF). Of the HPs, one third implemented lot quality assurance sampling (LQAS) based data quality check and 60.4% documented and followed execution of decisions. Overall, among the eligible women, 40% used ANC, close to 50% of currently married women used ANC services; 28% of women that fall in the high wealth index category used PNC within 48 hours after delivery; and 86.1% of women who had at least a high school education delivered at a health facility. Implementation of CHIS and family folder utilization and conducting LQAS based data quality check in the HPs were significantly associated with increased odds of ANC, delivery, and vaccination services use. Conclusion: We found that better implementation of CHIS was associated with better maternal and child health service use which implies that increasing utilization of CHIS at HPs will improve mother and child health service use.

Sexual and reproductive health service utilization of young girls in rural Ethiopia: What are the roles of health extension workers? Community-based cross-sectional study.

OBJECTIVE: Little is known about the extent to which Health Extension Programme (HEP) has played its role to increase service uptake among young girls. This study aims to estimate the status of young girls' sexual and reproductive health (SRH) services utilisation in rural Ethiopia and to examine the role of health extension workers (HEWs) in this regard. DESIGN: A cross-sectional study. SETTING: A community-based study among all nine regions of Ethiopia. PARTICIPANTS: Nine hundred and two young girls aged 15-24 years were included in this study. METHOD: We used data from the national HEP assessment, collected from March to May 2019. Multilevel binary logistic regression was used to investigate the association between exposure to HEP and SRH services utilisation of young girls and we reported an adjusted OR with a corresponding 95% CI as measure of the degree of associations. RESULT: Only 19.18% (95% CI 16.74% to 21.89%) of young girls used SRH services with significant regional variability (intraclass correlation coefficien=17.16%; 95% CI 6.30% to 39.99%). Exposure to HEP (adjusted OR, aOR 3.13, 95% CI 2.03 to 4.85), knowing about the availability of HEP services (aOR 3.06, 95% CI 1.75 to 5.33) and having good trust in HEWs (aOR 1.82, 95% CI 1.07 to 3.10) and other sociodemographic factors were significantly associated with increased SRH services utilisation. OUTCOME: SRH service utilisation. CONCLUSION: Although the overall SRH service utilization of young girls in rural Ethiopia was very low, HEWs have a great contribution to improving service utilization of young girls through strong health education provided during home visits, school visits and at health posts. More investment along this line has the potential to improve service uptake among young girls. Encouraging HEWs to build trust among this segment of the population and creating awareness of SRH-related services is crucial to improv service uptake.

Unmet need for family planning among rural married women in Ethiopia: What is the role of the health extension program in reducing unmet need?

BACKGROUND: Ethiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia. METHODS: This paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP. RESULTS: The overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37-0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67-0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67-2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01-1.48) were associated with a higher likelihood of an unmet need for FP. CONCLUSION: The unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women.

Family planning is a method that couples can use to limit the number of child or space the gap. Unmet need for family planning is defined as the percentage of reproductive age women who wants to space or limit the number of children but not currently using any family planning method. There is a huge proportion of eligible women have an unmet need for family planning in Ethiopia. The health extension program is one of the strategies to reach rural women to improve the health of the community. Although, family planning service is one of the packages in a health extension program and this study aimed to estimate the role of health extension program in reducing unmet need for family planning. About 4991 married women were asked about the family planning use, need and the place where they get the services. During the assessment the role of health extension program was assessed by different question. Some of the major assessment areas were women exposer to service, service availability, awareness and mode of service delivery. One fourth of the women have unmet need for family planning. The family planning utilization is still low. The contribution of the health extension program in family planning service is significant. Women exposed to HEP through level 4 health extension worker and older age are significantly associated with low level of unmet need FP. The unmet need for family planning is high in rural Ethiopia. This will inform the improvement and sustainability of the program.

Continuum of maternity care among rural women in Ethiopia: does place and frequency of antenatal care visit matter?

INTRODUCTION: The ministry of health (MOH) of Ethiopia recommends 4 or more focused antenatal care (ANC) visits at health centre (HC) or at a higher level of health facility (HF). In Ethiopia, few studies investigated time dimension of maternal health continuum of care but lack data regarding place dimension and its effect on continuum of care. The aim of this study is to estimate effect of place of ANC-1 visit and adherence to MOH's recommendations of MOH for ANC visits on continuum of care rural in Ethiopia. METHODS: We used data collected from 1431 eligible women included in the National Health Extension Program (HEP) assessment survey that covered 6324 households from 62 woredas in nine regions. The main outcome variable is continuum of care (CoC), which is the uptake of all recommended ANC visits, institutional delivery and postnatal care services. Following descriptive analysis, Propensity Score Matching was used to estimate the effect of place of ANC-1 visit on completion of CoC. Zero inflated Poisson regression was used to model the effect of adherence to MOH recommendation of ANC visits on intensity of maternal health continuum of care. RESULT: Only 13.9% of eligible women completed the continuum of care, and place of first antenatal care (ANC) visit was not significantly associated with the completion of continuum of care (ß = 0.04, 95% CI = -0.02, 0.09). Adherence of ANC visit to the MOH recommendation (at least 4 ANC visits at higher HFs than health posts (HPs)) increased the likelihood of higher intensity of continuum of care (aIRR = 1.29, 95% CI: 1.26, 1.33). Moreover, the intensity of continuum of care was positively associated with being in agrarian areas (aIRR = 1.17, 95% CI: 1.06, 1.29), exposed to HEP (IRR = 1.22, 95% CI: 1.16, 1.28), being informed about danger signs (aIRR = 1.14, 95% CI: 1.11, 1.18) and delivery of second youngest child at HF (IRR = 1.16, 95% CI: 1.13, 1.20). Increasing age of women was negatively associated with use of services (IRR = 0.90, 95% CI: 0.87, 0.94). CONCLUSION: Completion of maternal health continuum of care is very low in Ethiopia, however most of the women use at least one of the services. Completion of continuum of care was not affected by place of first ANC visit. Adherence to MOH recommendation of ANC visit increased the intensity of continuum of care. Intensity of continuum of care was positively associated with residing in agrarian areas, HEP exposure, danger sign told, delivery of second youngest child at health facility. To boost the uptake of all maternal health services, it is crucial to work on quality of health facilities, upgrading the infrastructures of HPs and promoting adherence to MOH recommendations of ANC visit.

Maternal health continuum of care is an integrated service delivery of antenatal care, facility delivery and postnatal care on appropriate time and place. Continuum of care averts more maternal mortality than individual service provision. In Ethiopia a small percent of women complete continuum of care. Previous studies in Ethiopia explored the effect of time on CoC, however the effect of place of service delivery on subsequent continuum of care were not addressed. This study, therefore, assessed the effect of place of service delivery on completion of subsequent continuum of care using data from 1431 fixed cohort of women during the National HEP assessment survey.The proportion of women who took all essential maternal health services was very low. Whether first antenatal care is at health post or at health centre did not have a significant effect on the completion of maternal health continuum of care. Adherence to the existing recommendations of Ministry of Health for antenatal care visit increases the uptake of maternal health continuum of care. Better completion of maternal health services was observed in agrarian than pastoralist areas, among those who have exposure to health extension program, who have information about danger signs, and who deliver their previous child at health facility. We can conclude that good implementation of the health extension program, and improving service quality at health facilities increase the uptakes of maternal health service. Moreover, promoting adherence of women to the ministry of health ANC recommendations increase uptakes.

Evaluation of Abortifacient Effect of Rumex nepalensis Spreng Among Pregnant Swiss Albino Rats: Laboratory-Based Study.

BACKGROUND: Rumex nepalensis Spreng (Amharic: Yewsha Tult) belongs to the Polygonaceae (buckwheat) family. In Ethiopia, the plant is traditionally used for the treatment of stomach ache, tonsillitis, ascariasis, uterine bleeding, etc. An ethnobotanical study from Mizan-Tepi University also reported the use of the plant by "Shekicho" people as an abortifacient. As a result, this study aimed at the assessment of the outcome of hydro-ethanolic leaves extract of R. nepalensis on Swiss albino pregnant rats and confirm its abortifacient activity. METHODS: The hydro-alcoholic leaves extract of Rumex nepalensis Spreng was evaluated for its abortifacient activity in Swiss albino rats. The mature female rats were mated overnight to male rats in mating cages. Two different dosage regimens (300 mg/kg, 600 mg/kg) of the extract were administered. Laparotomy was performed on the rats to assess the uterus and ovary, the viable, non-viable, adsorbing sites, and corpora lutea. Differences between the experimental and control groups were compared using one-way analysis of variance (ANOVA), followed by Dunnett's T-test to determine their level of significance. RESULTS AND DISCUSSION: This study revealed that Rumex nepalensis Spreng had anti-implantation and abortifacient activities at both 300 and 600 mg/kg doses, which was statistically significant as compared with the controls. It was relatively safe up to the dose of 5000 mg/kg, where no mortality and organ toxicity were manifested. Phytochemicals identified were alkaloids, flavonoids, saponins, tannins, steroids, and anthraquinones. CONCLUSION: In general, our study showed that R. nepalensis had a significant abortifacient activity that testifies its traditional dibs. Therefore, the use of this plant should be avoided in pregnant women to minimize unintended abortion and further studies are needed to know its mechanism of activity and to identify the phytochemicals corresponding to this activity. Checking its efficacy on other species is also needed.

The significant association between maternity waiting homes utilization and perinatal mortality in Africa: systematic review and meta-analysis.

OBJECTIVE: A proper uptake of maternity waiting homes (MWHs) is important to improve maternal and child health (MCH). The aim of this review is to generate the best existing evidences concerning the MWHs utilization and its impact on perinatal mortality (PNM) among pregnant mothers in Africa. Both relevant quantitative and qualitative studies, investigated and reported from databases were explored. Meta-analysis of the studies was displayed by tables and forest plots. The Stata version 14 was used with the fixed effect model and 95% confidence interval. RESULTS: In this review, a total of 68,805 births were recorded in this review. About 1.6% and 7.2% PNM occurred among non-exposed and exposed mothers respectively. Fifty percent of the studies showed there is a significant association between MWHs use and PNM. Meta-analysis revealed that utilizing MWHs have a significant effect in a reducing PNM by 82.5% (80.4%-84.5%), I2 = 96.5%. Therefore, use of MWHs has a potential to reduce PNM among pregnant mothers. The review revealed that MWHs relevance to achieving sustainable development goals (SDGs) concerning reducing newborn mortality. Therefore, the utilization rate of MWHs must be enhanced to achieve SDGs.

Role of maternity waiting homes in the reduction of maternal death and stillbirth in developing countries and its contribution for maternal death reduction in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Every family expect to have a healthy mother and new born baby after pregnancy. Especially for parents, pregnancy is a time of great anticipation. Access to maternal and child health care insures safer pregnancy and its outcome. MWHs is one the strategy. The objective was to synthesize the best available evidence on effectiveness of maternity waiting homes on the reduction of maternal mortality and stillbirth in developing countries. METHODS: Before conducting this review non-occurrences of the same review is verified. To avoid introduction of bias because of errors, two independent reviewers appraised each article. Maternal death and stillbirth were the primary outcomes. Review Manager 5 were used to produce a random-effect meta-analysis. Grade Pro software were used to produce risk of bias summary and summary of findings. RESULT: In developing countries, maternity waiting homes users were 80% less likely to die than non-users (OR = 0. 20, 95% CI [0.08, 0.49]) and there was 73% less occurrence of stillbirth among users (OR = 0.27, 95% CI [0.09, 0.82]). In Ethiopia, there was a 91% reduction of maternal death among maternity waiting homes users unlike non-users (OR = 0.09, 95% CI [0.04, 0.19]) and it contributes to the reduction of 83% stillbirth unlike non-users (OR = 0.17, 95% CI [0.05, 0.58]). CONCLUSION: Maternity waiting home contributes more than 80% to the reduction of maternal death among users in developing countries and Ethiopia. Its contribution for reduction of stillbirth is good. More than 70% of stillbirth is reduced among the users of maternity waiting homes. In Ethiopia maternity waiting homes contributes to the reduction of more than two third of stillbirths.

Treatment Outcome and Adverse Events of Tenofovir Disoproxil Fumarate Based Regimens as Compared to Zidovudine Based Regimens Among People Living with HIV/AIDS: A Systematic Review and Meta-Analysis of Observational Studies.

BACKGROUND: Findings from different studies report inferior clinical and virologic efficacy with TDF/3TC/NVP. But, some studies show that, there was no statistically significant difference in mortality among ZDV and TDF based regimens. The objective of this review was to systematically identify, appraise and synthesize the best available evidence on efficacy and safety of TDF based regimen as compared to ZDV based regimens. METHODS: A three-step search strategy was used to locate published and unpublished studies. First, an initial limited search of google was undertaken followed by analysis of text words. A second extensive search was undertaken. We searched the PubMed, EMBASE, Google Scholar, Medline, and CINHAL. We did the initial search for articles on July 11-18, 2016, and updated the results on May 13, 2017.Third, the reference lists of all identified articles was searched for additional studies. RESULTS: ZDV based regimens had better outcome on prevention of mortality (OR=1.31, 95%CI (1.14, 1.50), I2 = 0%, Chi2 = 2.51), and lower virologic failure (OR = 1.44, 95% CI [1.18, 1.76], chi2 = 5.91, P= 0.003, I2 =83%) while, TDF based regimens were more tolerable (OR=0.15, 95%CI (0.08, 0.30), I2 = 40%, Chi2 = 3.31). The difference in incidence of opportunistic infection is not significant (OR = 0.83, 95% CI [0.52, 1.32], chi2 = 0.11, P= 0.42, I2 =0%). CONCLUSION: There is lower mortality and lower virologic failure in ZDV group, but better safety profile among TDF based regimens.

Sleep correlates of substance use in community-dwelling Ethiopian adults.

PURPOSE: The relationship between sleep disturbances and substance use can have harmful effects. Evidence shows widespread use of substances, including khat, in the Ethiopian population. However, to the best of our knowledge, no study has investigated the sleep correlates of substance use in community-dwelling Ethiopian adults. MATERIALS AND METHODS: A cross-sectional study using simple random sampling was performed on community-dwelling adults (n = 371, age = 25.5 ± 5.7 years, body mass index = 22.0 ± 2.2 kg/m2) in Mizan-Aman, Ethiopia. Dichotomized sleep measures (sleep quality and sleep latency) assessed by the Pittsburgh Sleep Quality Index (PSQI) were used in association analysis using binary logistic regression with substance use (khat, smoking, and alcohol). RESULT: Sleep latency was associated with khat chewing (adjusted odds ratio (AOR) = 2.8, 95% confidence interval (CI) 1.7-4.4) and tobacco smoking (AOR = 2.1, 95% CI 1.4-3.0). Sleep quality was associated with khat chewing (AOR = 3.1, 95% CI 1.8-5.2), tobacco smoking (AOR = 1.7, 95% CI 1.2-2.5), and alcohol intake (AOR = 1.9, 95% CI 1.1-3.1). CONCLUSION: Sleep correlates of substance use were found in community-dwelling Ethiopians. These findings may aid in the development of targeted strategies to manage substance use-related sleep disturbances.

Estimates of Uterine Rupture Bad Outcomes Using Propensity Score and Determinants of Uterine Rupture in Mizan-Tepi University Teaching Hospital: Case Control Study.

BACKGROUND: Uterine rupture is a tear in the wall of uterus which carries grave risks to the mother as well as her baby. OBJECTIVES: To estimate uterine rupture bad outcomes using propensity score and its determinants in Mizan-Tepi University teaching hospital. METHODS: A case control study on 363 participants, 121 cases and 242 controls, was conducted. Data was analyzed by STATA 14. Propensity score matching analysis was used to see causes. Level of significance of p value is ≤0.05. RESULTS: Females who reside in rural areas (AOR = 3.996; 95% CI: 2.011, 7.940) are at higher risk of acquiring uterine rupture. Females who had ANC follow-up (AOR = 0.315; 95% CI: 0.164, 0.606) and preterm gestational age (AOR = 0.135; 95% CI: 0.025, 0.725) are at lower risk of developing uterine rupture. Propensity score matching analysis shows that, from 100 participants who had uterine rupture, 88.4 females lost their fetus (ß = 0.884; 95% CI: 0.827, 0.942). From 100 females who develop uterine rupture, 9.1 died (ß = 0.091; 95% CI: 0.040, 0.142). From 100 females who develop uterine rupture, 97.5 developed additional obstetric complication (ß = 0.975; 95% CI: 0.947, 1.000). CONCLUSION: Residence, ANC follow-up, and gestational age are significant determinants of uterine rupture. Fetal loss, maternal death, and obstetric complications are significant bad outcomes of uterine rupture.

Efficacy and Tolerability of Tenofovir Disoproxil Fumarate Based Regimen as Compared to Zidovudine Based Regimens: A Systematic Review and Meta-Analysis.

BACKGROUND: Although tenofovir (TDF)/emtricitabine (FTC)/efavirenz (EFV) and zidovudine (ZDV)/lamivudine (3TC)/efavirenz (EFV) are used as preferred first line regimen, their head-to-head comparison in terms of their efficacy and tolerability was limited. This review aimed to synthesize the best available evidence on the comparative efficacy and tolerability of the two regimens. METHODS: Seven sites and databases in addition to Google search until August 20, 2016, were searched. Only randomized clinical trials conducted on adult population were included in this study. Our primary outcome was viral load suppression while secondary outcomes were death and tolerability. Undetectable viral load is defined as <50 Human Immunodeficiency Virus (HIV) ribonucleic acid (RNA) copies/ml. Joanna Briggs institute meta-analysis of statistics assessment and review instrument (JBI-MAStARI) and critical appraisal and data extraction tool were applied for critical assessment and data extraction, respectively. We performed a random effect meta-analysis to pool the relative risk (RR) for viral load suppression (<50 HIV RNA copies/ml and <400 HIV RNA copies/ml), tolerability, and death. RESULT: Data was extracted from four articles, which included a total of 2381 participants. We found superior viral load suppression among tenofovir (TDF) arm compared to zidovudine (ZDV) arm. Tenofovir arm achieves viral load <50 HIV RNA copies/ml (RR = 1.12, 95% confidence interval (CI) [1.04, 1.21], I2 = 0%) higher than zidovudine arm. Similarly TDF arm is superior in viral load suppression to <400 HIV RNA copies/ml (RR = 1.19, 95% CI [1.11, 1.27], I2 = 0%). Moreover, TDF based regimens were more likely to be tolerated than ZDV based regimens (4 trials, 2381 participants (RR = 1.06, 95% CI [1.02, 1.10], I2 = 51%)). However, forest plot of death shows that it was not significant (RR = 0.91, 95% CI [0.51, 1.62]). CONCLUSION: The use of TDF/FTC/EFV as first line regimen for naïve HIV-1 infected adult patient showed superior viral load suppression and tolerability as compared to ZDV/3TC/EFV. In order to compare the death outcome of both ZDV/3TC/EFV and TDF/FTC/EFV further research is needed.

Determinants of stillbirth in Bonga General and Mizan Tepi University Teaching Hospitals southwestern Ethiopia, 2016: a case-control study.

OBJECTIVE: This study aimed to identify determinants of still birth in selected hospitals of Southwestern Ethiopia. RESULT: A total 540 charts registered for maternal health services utilization were included in the analysis with proportion of case to control ratio of one to three (135 cases, 405 control). Women who attended antenatal care were 40% less risk for stillbirth compared to those who did not attend antenatal care (AOR = 0.6, 95% CI 0.39, 0.94). Those who had labor length ≥ 24 h were 2.4 times at risk to have still birth than ≤ 24 h (AOR = 2.44, 95% CI 1.4, 4.26). Women who developed uterine rupture were about 5 times more likely to have still birth than did not develop the complication (AOR = 4.9, 95% CI 1.67, 14.35). Women who have different antenatal risks were 4.5 times more likely to have still birth (AOR = 4.58, 95% CI 1.45, 14.48). Weight of baby ≥ 2.5 kg were 73% less likely to still birth when compared to counterparts (AOR = 0.27, 95% CI 0.14, 0.53).